Health Disparities Don't Discriminate, But Our Healthcare System Surely Does
What acknowledging, unlearning, and combating our bias has to do with improving healthcare.
Have you ever experienced a moment that shifted everything you thought you knew? For me, it was December 2019 when I was diagnosed with rheumatoid arthritis and Sjögren's syndrome. Despite living what I thought was a healthy lifestyle, I faced the harsh reality that health disparities don't discriminate based on how well you take care of yourself.
Despite Secretary Robert F. Kennedy, Jr’s mandate to Make America Healthy Again through the Department of Health and Human Services (HHS), it’s not lost on me (or you) that addressing the root causes of America’s escalating health crisis requires addressing the social determinants of health (SDoH) that have contributed to those disparities in the first place. From economic instability to lack of quality health care access, significant barriers exist that contribute to the adverse health outcomes that the U.S. population faces.
It wasn’t until I got diagnosed with RA and Sjögren’s that I began to understand that improving health outcomes starts with changing the system, not the individual. By this, I mean that I started writing for Enhance Black Women’s Health because I believe equipping healthcare providers with strategies to challenge bias, reduce disparities, and deliver equitable care will improve the health outcomes for Black women.
Yes, I care about that as a Black woman and someone who knows that the ripple effect of improving the health of the most historically marginalized groups in the U.S. means that everyone else’s health improves too. I also care about this, knowing that it wasn’t until my diagnosis of RA and Sjögren’s that I began to understand how weight-centric our healthcare system is.
Whether you realize it or not, weight bias in healthcare significantly impacts diagnosis and treatment options for patients. For instance, before my diagnosis of RA and Sjögren’s, my general practitioner (GP) was solely concerned with the fact that even though I “looked fit my body mass index (BMI) was high and I could stand to eat more salads.”
She never asked what I ate, so she had no clue how many salads I did or didn’t eat. The point isn’t my salad intake as much as it was about her assumptions about me based solely on my BMI. Beyond the fact that it has been proven that BMI is an inaccurate health metric, my GP’s focus exclusively on my BMI to determine what she thought I should be concerned with when it came to my health. The consequence of her weight bias against me is that it caused her to ignore the symptoms of my autoimmune disease. In my opinion, I could have been diagnosed two years sooner had she listened to my concerns instead of dismissing them.
As much as I wish my story were an isolated incident, as I began to dive more into research, I would soon discover how dismissing patient concerns is common and can contribute to serious adverse health outcomes. One such case is that of a 54-year-old woman, let’s call her “Jane” who was experiencing abdominal bloating and unintentional weight gain, and after consulting with her healthcare team, they diagnosed her with ob*sity (Palmese et al., 2021). After a physical examination with a computed tomography (CT) scan, her healthcare team discovered a mass in her abdomen weighing 46 kg (101 lbs) and a tumor composed of three different areas. In other words, this woman, who had brought up concerns of pain in her abdomen, was grotesquely misdiagnosed as being ob*se when in actuality she was carrying around a growing tumor.
I share my journey as a patient experiencing weight bias as well as Jane’s experience with weight bias to illustrate the importance of treating each patient as a whole person, not just a number on a scale. In my case it delayed me getting a proper diagnosis, however in Jane’s case it was far more serious. Her tumor could have taken her life, which would have been a preventable death.
As a healthcare provider, you hold the power to make a meaningful change in our healthcare system by integrating a weight-inclusive approach in your practice. If you’re wondering exactly how to do that, here are three ways that you can get started:
Acknowledge Your Bias: The first step is identifying and recognizing biases in ourselves and healthcare systems. You must understand that you might hold prejudices or assumptions about your patients or clients' identity that impact your care. For instance, the assumption that Jane wasn’t following her dietary plans caused her healthcare team to assume that her weight gain was related to that instead of an underlying medical condition.
Unlearn Your Bias: After acknowledging biases, the next step is actively working to unlearn them. This involves challenging your long-held beliefs, educating yourself about different cultures and identities, and recognizing the harmful impacts of these biases. If Jane’s healthcare team had done this, they would have investigated her abdominal pain more rather than diagnosing her as being ob*se without conducting a physical examination.
Combat Your Bias: This is the actionable step of implementing what you've learned. When you combat your bias, you interrupt biased behavior, advocate for others when you see bias in action, and strive to provide equitable care. In Jane’s case, this would have meant her healthcare team questioning their assumptions, which could have prevented them from deciding about her health based on bias.
In essence, acknowledging your bias, unlearning it, and combating it can improve care delivery, ensuring everyone gets the equitable care they desire. Whether you’re a healthcare provider seeking a more equitable approach to care or a patient looking to experience more equitable care, know I’m here to support you on this journey.
Let's keep this conversation going. Comment below and share your thoughts or experiences with weight bias in healthcare. I’m interested in hearing your experience and any lessons you have to share.
Take care,
Tomesha
P.S. Keep an eye out for our upcoming minicourse designed just for you—a step toward transforming care delivery.
Reference
Palmese, F., Reggidori, N., Pappas, G., & Gramenzi, A. (2021). More than a "monstrous obesity"! Time to overcome the "anti-fat" bias. Clinical obesity, 11(1), e12413.